Excessive absenteeism and chronic pain

How much is too much and why breaking the cycle of pain is essential to improving attendance

Published Date: Nov 6, 2023

There are several possible reasons for excessive employee absenteeism, from disengagement and burnout to family obligations and more. Significant amounts of missed work time can be grounds for termination, but it can also be a potential sign of an ongoing struggle or need your employee could use your help with.

Chronic pain is considered a ‘high-impact’ health problem when it comes to both absenteeism and presenteeism, excessive or otherwise. People living with musculoskeletal (MSK) pain miss an average of 10.3 days of work each year due to related issues such as debilitating symptoms, limited mobility, and mental health challenges.

While time away from work due to health issues is what sick time is for, this amount of time often exceeds allowances and enters excessive absenteeism territory in the minds of many employers. This is especially so when direct and indirect costs related to things like compromised operations, missed deadlines, and reduced morale of other employees start to mount. This article explores the link between chronic pain and absenteeism, how to talk with employees about excessive absenteeism, and ways that companies can provide chronically absent employees with the support they need.

What is considered excessive absenteeism?

The Society for Human Resource Management (SHRM) defines excessive absenteeism as two or more instances of an unexcused absence in a 30-day period. How your company defines it may differ.

Attendance policies should clearly outline what qualifies as an excused and unexcused absence, keeping in mind that certain types are protected under state laws. They should also set thresholds that draw the line between acceptable and excessive absenteeism, regardless of the reason.

Communicating with workers about excessive absenteeism is important. In some cases, an employee may be a candidate for leave under the federal Family and Medical Leave Act (FMLA). This legislation provides eligible employees of covered employers with up to 12 work weeks of unpaid, job-protected leave in a 12-month period for specified family and medical reasons.

Present, but less productive

Presenteeism is another concern that can significantly impact your business. This occurs when employees report to work, but their performance is below expectations because they are unwell or unfocused.

Many of the same factors that cause absenteeism can result in presenteeism. To put the impact of MSK issues in perspective, the 2020 Global Pain Index reported that 80% of workers say they are less focused or less productive when they are experiencing pain.

Many of the most preventable absences are related to MSK conditions, such as sprains to the shoulder and lumbar regions, carpal tunnel syndrome, rotator cuff syndrome, and pain in the lower back and joints. That said, the rate of new cases of chronic pain continues to climb. 

The reality is that chronic pain may never be something that fully goes away. But it can improve if properly managed.

The cyclic nature of chronic pain is very much at the root of this. In short, nerves that relay pain messages to the brain don’t stop sending signals even if someone has physically recovered. The brain responds, perpetuating pain. And since pain and depression share neurotransmitters and biological pathways, depression outcomes such as health-related quality of life and work function are adversely affected as pain levels increase—and vice versa. 

In a sample of 217 patients with depression, people experienced pain on more than half the days over a three-month period. This resulted in 16 days where usual activities had to be curtailed, four days of missed work or school, and at least one visit to a physician or clinical nurse.

Unfortunately, more than a third of people either wait more than a year to seek treatment to help manage their pain or never seek it at all, often due to barriers to care such as proximity to a provider, scheduling challenges, and cost.

Employees in pain may rack up an excessive amount of absences because of physical symptoms, mental symptoms, or both. And they may not even be aware of the extent to which one begets the other.

The impact of excessive absenteeism on your business

There are both direct and indirect costs of excessive absenteeism, including:

  • Wages for employees who use paid leave when they are out of work

  • Overtime pay when hourly employees are asked to take on an absent colleague’s tasks

  • Expenses related to the hiring and training of temporary workers

  • Healthcare costs related to a related health issue, if applicable

  • Reduced productivity and/or work quality

  • Costs associated with missed deadlines

  • Administrative costs related to rescheduling employees, documenting excessive absenteeism, etc.

If you consider that on any given day in the United States, around 3% of an organization’s workforce is absent, the economic costs of absenteeism may be quite significant.

Absenteeism and presenteeism cost U.S. employers $2,945 per employee per year, overall. And one study found that the annual, incremental costs of lost work productivity among U.S. employees with a variety of health conditions ranged from $100 to $10,000 per person; the highest costs were associated with individuals with pain, depression, or cancer.

From an operational perspective, excessive absenteeism can negatively impact workforce morale. When employees are asked to pick up the slack for absent colleagues, they may feel overburdened and disengaged. Overburdened workers are often more error prone. This could lead to physical injuries, lower quality customer service, or reputational damage for companies. 

How to talk to an employee about excessive absenteeism

When it comes to attendance issues, it’s important to apply policies fairly to everyone, document time taken, and discuss any concerns promptly.

Set up a meeting to discuss the excessive absenteeism. Allow for open discussion about the reason(s) behind the situation; you may learn something you are not aware of. Be clear about attendance policies and the impact time off has on operations, while also expressing concern and care for any struggles.

Note, however, that while an employee can choose to offer up information related to any health and personal issues, confidentiality laws prevent you from asking for it directly.

Can I ask an employee for a doctor’s note?

Yes. If an employee has been taking sick leave, employers may ask for a note from a healthcare provider after a number of days of their choosing. You cannot require that it include a diagnosis. You can ask the practitioner to verify that they evaluated the employee, as well as outline any job-related restrictions or periods of incapacity associated with the employee’s condition.

Under certain circumstances, sick leave may need to transition to disability or FMLA-protected leave. Important points to note include:

  • Under the Americans With Disabilities Act, if a disability or need for accommodation isn’t apparent, an employer can request more information from a doctor to determine if the employee’s impairment could be considered an ADA disability.

  • The U.S. Equal Employment Opportunity Commission offers enforcement guidance for disability-related inquiries and medical examination of employees under the ADA.

  • Under FMLA, employers can request a completed certification from an employee’s healthcare providers, substantiating the need for FMLA leave.

SHRM published a case review related to enforcing absenteeism policies without violating FMLA and ADA requirements that you may find useful when navigating this complex issue.

When you offer unlimited paid time off

Unlimited paid time off (PTO) is becoming a more popular company benefit. While a definite perk for both companies and employees, it can make conversations about excessive absenteeism a bit harder to have.

There can be limits on unlimited PTO, and it’s best practice to establish them upfront. For example, your organization may want to limit the number of consecutive days that can be taken off, create multiple approval levels for PTO, and clearly define how the company will address suspected abuse. 

Keeping accurate records of how many days employees take off is critical, whether your organization offers unlimited PTO or not. Some states require employers to track employee work hours, PTO accruals, and usage. It’s important to stay abreast of laws in your location and design a compliant policy.

Ways to support chronically absent employees

When someone is absent a lot for a health reason, they may wish they could change that just as much as you do.

As you develop a plan to help reduce excessive absences due to chronic pain or another health issue, here are three tips that may help:

  1. Ask an open-ended question like, “How can we better support you so you can miss fewer workdays?” The feedback you receive may surprise you and help you identify opportunities to help your employees be their best selves. Just asking may also help employees realize that you are invested in their wellness and success.

  2. Consider whether offering employees more flexibility could help. You might provide schedule flexibility or work-from-home options. Alternatively, you might decide to permit over-limit absences if the employee can set up schedule swaps and find coverage internally.

  3. Look for trends that may indicate gaps in your benefits. For example, if employees are often out due to pain and MSK healthcare claims are high, they may not be getting the care they need—even if you already offer health insurance.

How Hinge Health can help you

Joint or muscle pain touches virtually every area of your business. Sufferers are less productive and more likely to be absent or prone to presenteeism. And with rates of new chronic pain cases soaring, already-high related healthcare costs will only continue to grow.

Hinge Health is a clinically complete MSK care approach that keeps members engaged. For everything from minor sprains to chronic pain, our care team uses advanced technology to manage member pain and remove barriers to recovery.

Studies demonstrate that our powerful, clinically validated digital MSK solution yields positive long-term outcomes and claims reductions.

There are many health issues you can’t have much of an impact on.

This isn’t one of them.

Let’s talk about how we can get to work for you.

Traditional MSK Care Is Falling Short

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